Provider Demographics
NPI:1225114085
Name:DOERFLER, GREGORY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWARD
Last Name:DOERFLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:493 DUANE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4501
Mailing Address - Country:US
Mailing Address - Phone:630-858-5755
Mailing Address - Fax:630-858-5760
Practice Address - Street 1:493 DUANE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4501
Practice Address - Country:US
Practice Address - Phone:630-858-5755
Practice Address - Fax:630-858-5760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL241210Medicare ID - Type Unspecified